Search

Patient comorbidities may affect the applicability of performance measures that are inherent in multidisciplinary cancer treatment guidelines. This article describes the distribution of common comorbid conditions by disease site and by patient and facility characteristics in patients who received radiation therapy as part of treatment for cancer of the breast, cervix, lung, prostate, and stomach, and investigates the association of comorbidities with treatment decisions.Stratified two-stage cluster sampling provided a random sample of radiation oncology facilities. Eligible patients were randomly sampled from each participating facility for each disease site, and data were abstracted from medical records. The Adult Comorbidity Evaluation Index (ACE-27) was used to measure comorbid conditions and their severity. National estimates were calculated using SUDAAN statistical software.Multivariable logistic regression models predicted the dependent variable "treatment changed or contraindicated due to comorbidities." The final model showed that ACE-27 was highly associated with change in treatment for patients with severe or moderate index values compared to those with none or mild (P.001). Two other covariates, age and medical coverage, had no (age) or little (medical coverage) significant contribution to predicting treatment change in the multivariable model. Disease site was associated with treatment change after adjusting for other covariates in the model.ACE-27 is highly predictive of treatment modifications for patients treated for these cancers who receive radiation as part of their care. A standardized tool identifying patients who should be excluded from clinical performance measures allows more accurate use of these measures.

e12027 Background: We reviewed our large, community hospital experience treating early stage breast cancer patients to determine rates of breast-conserving therapy (BCT), overall survival, and risk...

neoadjuvant hormone therapy (NAHT) versus (vs) those treated with neoadjuvant chemotherapy (NACT) followed by surgery with or without radiation (XRT). Materials/Methods: We reviewed the records of 110 consecutive postmenopausal women treated pre-operatively with either NAHT or NACT from 2004 to 2011. We included subjects with non-metastatic, noninflammatory, ER+ breast cancer and excluded those with Her2neu positive tumors. We compared pathologic complete response (pCR) and breast conserving surgery (BCS) rates as well as long-term rates of local control, distant metastasis free survival (DMFS), and overall survival (OS). Results: Median follow-up time for all patients was 45.7 months. Twentyeight subjects received NAHT, while 82 received NACT. The most commonly prescribed NAHT was an aromatase inhibitor (93%) followed by tamoxifen (7%). Median duration of NAHT was 8.0 months. Fifty-six percent of NACT patients received an anthracycline (A) and taxane-based regimen, while 33% of patients received an A-based regimen alone. Patients receiving NAHT were older than patients receiving NACT (Median age 67 vs 58 years, p < 0.01). There were no significant differences in initial T stage, clinical tumor size, progesterone receptor status, tumor grade, or histology between groups. NACT patients, however, had more advanced N stage compared to NAHT patients (p Z .03). All NAHT patients had residual invasive cancer at the time of surgery, while 7.3% of NACT subjects achieved a pCR (p Z 0.1). Indeed, NACT patients were more likely to develop any pathologic response to treatment (median tumor size decrease of 1.7 cm vs 1.0 cm in NAHT patients, p Z .05), but were less likely to undergo BCS than NAHT subjects (30% vs 68%, p < 0.01). Among BCS patients, 96% of the NACT vs 79% of NAHT patients received post-lumpectomy XRT (p Z .09). Among patients treated with mastectomy, NACT patients were more likely to receive XRT (78% vs 43%, p Z .05). Among all patients, only one patient developed a local recurrence following NAHT and mastectomy without XRT. There was no difference in 4-year DMFS or OS between groups. On multivariate analysis, tumor grade and N stage but not NAHT predicted for poorer OS. Conclusions: Our data suggests that although pCR rates following NAHT in post-menopausal patients with ER+ breast cancer are low, outcomes do not appear to be adversely affected by NAHT treatment in our patient population. NAHT appears to be a viable and potentially less toxic option in select post-menopausal women with ER+ breast cancer. Author Disclosure: D.M. Marcus: None. R. Prabhu: None. R. O’Regan: None. A. Zelnak: None. C. Fasola: None. D. Mister: None. M. Torres: None.

784 Background: Randomized studies and academic centers have demonstrated favorable outcomes after BCT for early stage breast cancer. There are few modern reports of BCT in community settings, validating its generalizability. We, as a large community practice, retrospectively reviewed our experience in treating early-stage breast cancer with BCT to determine outcomes and clinical, pathologic, and treatment risk factors. Methods: Tumor registry was used to identify breast cancer cases diagnosed between 1/1/87 and 12/31/94 and treated at Providence St Joseph's Hospital, a 455-bed, non-profit hospital in southern California, and 1 free-standing affiliate. Of the 1746 breast cancer cases, 744 were pathologic T1–2, N0 and had ≥ 8 years of potential follow up. Of these, 521 (70%) received BCT and are the topic of this review. We calculated crude rates of first failure at 8 years, classified as local failure (LF), distant or regional node failure (DNF), dead without failure (DWF), or alive without failure (AWF)....